Organization
ADVANCED SPINE ASSOCIATES PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARRY M BANKS M.D. (M.D.)
(763) 577-1877
Entity
Organization
Contact information
Practice address
8232 HIGHWAY 65 NE, SPRING LAKE PARK, MN 55432-2095
(763) 577-1877
(763) 577-1887
Mailing address
8232 HIGHWAY 65 NE, SPRING LAKE PARK, MN 55432-2095
(763) 577-1877
(763) 577-1887
Taxonomy
Speciality
Code
Description
License number
State
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
—
—
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
—
—
225100000X
Physical Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
713523800
—
MN
Enumeration date
08/31/2005
Last updated
12/17/2012
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